Safe Medication Management Research Articles

Fortification is required in the rear to win the battle of epidemic prevention and control

The current epidemic of Corona Virus Disease 2019 (COVID-19) poses a serious threat to people's health and lives Following the national policies and deployment, medical community in China invests large amounts of medical resources to help Hubei However, some hospitals nationwide have suspended outpatient and inpatient services The authors analyze the underlying causes of suspension of medical services and its harm to patients, and summarize the optimization of disease diagnosis and treatment during the COVID-19 outbreak In further, they propose reasonable suggestions on safe medical management in general hospitals outside the epidemic area, in order to attract the attention of medical institutions and medical colleagues Copyright © 2020 by the Chinese Medical Association

A qualitative exploration of the experiences of doctors, nurses and pharmacists regarding medication management in outpatient setting.

To understand how the medications are managed by the multidisciplinary team and their suggestions for nursing management, and to develop a framework for safe medication management in hospital-based outpatient. More than 80% of hospital-based outpatient visits involve medication prescriptions, indicating the importance of safe medication management there. This was a qualitative study with face-to-face interviews with physicians, nurses and pharmacists from 11 medical outpatient units. Four themes elicited were categorized as follows: unclear professional roles and functions in outpatient medication management; intertwined communications; moving from data to wisdom; and ambiguous culture of safety. The resulting model is a collaboration of physicians, nurses, pharmacists, and patients and families integrated with hospital administrative support and information technology in a culture of safety. Medication management in outpatient is critical but usually overlooked. Nursing leaders should develop a culture of safety and provide more support and training for nurses to provide comprehensive medication management for outpatients. It is important to develop outpatient nurses' role and competence in managing patient medication safety. Nurses in management would benefit from applying the 'framework of efficient and safe medication management for outpatients' to assess and identify weak areas for improvement.

Medical Safety Management System from the Perspective of a Multifactorial Model of Adverse Events in Medicine

Medical Safety Management System from the Perspective of a Multifactorial Model of Adverse Events in Medicine

Multifactorial model of adverse events and medical safety management

The article describes a multifactorial model of adverse events related to the provision of medical care. It is shown that their origin is caused by the transformation of systemic causes (latent failures) acting at the level of medical organization, external microenvironment and macro-factors. Four types of global latent failures are described at the level of a medical organization related to: medical technology, work of medical personnel, work environment, and patient behavior. At the external microenvironment level, major latent threats are concentrated at the level of partners, suppliers and outsourcers. Among macro-factors influencing medical care safety especially important are the legal factors defining the status of medical errors and their consequences; economic model of state health care; financial provision of state guarantees and rationing of these volumes in regions and municipalities; availability of state medical care safety management programs; state regulation of medical activity; system of pre- and post-graduate medical education; system of labor regulation and remuneration of medical workers; society's attitude towards medical errors and its participation in the process of medical care safety management. The authors present an algorithm for implementation of a safety management system in a medical organization, including the construction of a new safety culture, an accounting system for recording of threats and incidents, a model for managing medical care safety built into the operational system of the organization.

Discussion on Medication Safety Management in Nursing Work in Cardiology Department

Discussion on Medication Safety Management in Nursing Work in Cardiology Department

Hospital pharmacists' ethical exposure and decision-making.

Studies have explored community pharmacy ethical dilemmas; however, limited research exists on hospital pharmacy ethical issues and pharmacists' ethical decision-making processes. Research exploring this is timely, considering developments in hospital pharmacy practices, new hospital pharmacist roles, and evolving responsibilities. To explore hospital pharmacists' ethical decision-making and processes for managing ethical challenges in the context of evolving Australian hospital pharmacy practices. Face-to-face semi-structured interviews with 20 purposively-selected hospital pharmacists from four Queensland Health hospitals. An interview guide with 11 open-ended questions and prompts was developed, validated, and trialed. Pharmacists who consented received the guide prior to interviews. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo 12 to facilitate coding and thematic analysis. Participants were interviewed January to April 2019; median interview duration was 17.45min. Data saturation was reached. Participants' experiences ranged from junior level pharmacists to senior management positions, in clinical and non-clinical roles. Emerging themes were: 1) influences on the development of ethical decision-making skills, 2) ethical decision-making is an integral part of the hospital pharmacist's role, and 3) institutional requirements and settings impact on ethical exposure. A wide range of contemporary ethical issues unique to hospital pharmacy practice, mostly involving complex medication management safety, supply, and cost scenarios, were identified. Junior pharmacists indicated they would benefit from additional training, mentorship, and availability of hospital-specific targeted ethics resources. The findings highlighted that hospital pharmacists are regularly faced with ethical issues unique to the hospital pharmacy practice context. Application of sound and structured ethical reasoning and decision-making is, therefore, required in this setting. Participants identified many interrelated factors that impacted their ethical reasoning and behaviour. This study identified gaps that, once addressed, will better support ethical reasoning in hospital pharmacy settings.

Influence of medication environment on unsafe medication behaviors of nurses: a path analysis

Objective To explore the correlation between medication environment and unsafe medication behaviors of nurses and analyze the influence path so as to provide a scientific basis for nurses' safe medication management. Methods From January to February 2017, this study selected 1 243 nurses from two affiliated hospitals of Harbin Medical University, two provincial ClassⅢ Grade A hospitals and one municipal ClassⅢ Grade A hospital in Harbin by convenience sampling as subjects. Questionnaire survey was carried out with the general information questionnaire, the nurse medication unsafe behavior scale and the nurse medication environmental perception scale. Besides, a path analysis was implemented. A total of 1 243 questionnaires were sent out and 1 012 valid questionnaires were collected with 81.42% for the valid recovery rate. Results Among 1 012 nurses, the total scores of the nurse medication environmental perception scale and the nurse medication unsafe behavior scale were (134.96±16.28) and 8 (16) respectively, with a negative correlation and a statistical difference (r=-0.48, P<0.01) . Path analysis showed that software had a direct effect (β=-0.45, P<0.01) and an indirect effect by mediation of nurse (β=0.24, P<0.01) on unsafe medication behaviors of nurses; human components (β =-0.54, P<0.01) and nurses (β=-0.96, P<0.01) had direct effects on unsafe medication behaviors of nurses.Hardware and environment had not directly affected the unsafe behavior of nurses in medication, but had an indirect effect (β=0.08, 0.56; P<0.01) . Conclusions Medication environment is a predictor of unsafe medication behaviors. Nursing managers should positively improve the medication environment and comprehensive quality of nurses so as to reduce the occurrence of unsafe medication behaviors in nurses. Key words: Nurses; Medication environment; Unsafe medication behaviors; Path analysis

Assessing the cognitive and work load of an inpatient safety dashboard in the context of opioid management

For health information technology to realize its potential to improve flow, care, and patient safety, applications should be intuitive to use and burden neutral for frontline clinicians. We assessed the impact of a patient safety dashboard on clinician cognitive and work load within a simulated information-seeking task for safe inpatient opioid medication management. Compared to use of an electronic health record for the same task, the dashboard was associated with significantly reduced time on task, mouse clicks, and mouse movement (each p < 0.001), with no significant increases in cognitive load nor task inaccuracy. Cognitive burden was higher for users with less experience, possibly partly attributable to usability issues identified during this study. Findings underscore the importance of assessing the usability, cognitive, and work load analysis during the design and implementation of health information technology applications.

Relationship Between Nosocomial Infection Control and Medical Safety Management in Japan

Relationship Between Nosocomial Infection Control and Medical Safety Management in Japan

Research on the relationship between clinical ethics and medical safety management

Research on the relationship between clinical ethics and medical safety management

Vulnerable Strata to Non-Adherence and Overuse in Treatment for Patients with Cognitive Impairment.

Background and purposeAppropriate medication treatment could enable both cognitively impaired patients and caregivers to hold on their cognitive functioning and quality of life. Thus, medication management and the factors influencing how management for this condition is carried out must be identified. In this study we aimed to evaluate the frequency of medication nonadherence (MNA) or drug overuse for cognitive impairment (DOC) and to extract significant variables, including the demographic and social characteristics, vascular risk factors, and cognitive status, for the diagnosis of MNA and DOC in Korean patients.MethodsWe investigated patients aged over 50 years between March 2019 and June 2019 via the cognitive enHancement of patIents with acQuired cognitive impairment (HIQ) campaign. MNA was defined as a participant who was classified as having cognitive impairment but did not take any cognition-related drugs, whereas DOC was defined as a participant who had normal cognition but was taking cognition-related drugs.ResultsWe included 10,767 patients. The MNA group consisted of 337 participants, whereas the DOC group comprised 1,107 participants. The factors that could differentiate the MNA group from the normal-behavior group were age, education, sex, and the total Korean version of Mini-Mental State Examination (K-MMSE) score. The factors that could differentiate the DOC group from the normal medication-behavior group were age, sex, residential distinction, experience of a dementia screening test, and the total K-MMSE score.ConclusionsThe underlying factors contributing to inadequate dementia-medication management must be understood, and intervention or support is needed to enable safe medication management.

Adolescent and Parent Knowledge, Attitudes, and Perceptions of Harm of Household Controlled Medications

Introduction: Adolescents learn knowledge, attitudes, and behaviors from their parents, yet little is known about how these attributes are associated with management of household controlled prescription medications. We aimed to assess adolescent and parent: 1) knowledge and attitudes regarding household controlled medications, including previous healthcare counseling; 2) perceptions of harm of medication misuse and diversion; and 3) potential associations of these attributes with household management. Methods: This was a cross-sectional study with paired data using brief, online, confidential surveys of adolescents and parents via an adolescent medicine clinic associated with a large academic center. Eligible adolescents were aged 12–18 years old with at least one controlled prescription medication in the home. Data collection and analysis occured in 2017–2018. Results: Of the 243 adolescent-parent dyads, many adolescents and parents had: low knowledge (15%; 6%), risky attitudes (31%; 32%), received healthcare counseling on safe management of controlled medications (30%; 96%), and low perceived harm of adolescent diversion (39%; 49%). Parents practicing unsafe household management were 2.4 (95% CI = 1.3, 4.3) times as likely to have risky attitudes. Adolescents with families practicing unsafe medication management were 3.7 (95% CI = 1.1, 10.4) times as likely to have low perceptions of harm from diversion. Conclusions: Many adolescents and parents have low knowledge, risky attitudes, and low perceptions of harm of adolescent diversion, some of which are associated with unsafe household medication management. Providers should aim to utilize interventions to improve these attributes for adolescents and parents to enhance safe household medication management.

Brown Bag Simulation to Improve Medication Management in Older Adults.

Medical students must care for aging patients with growing medication lists and need training to address negative patient outcomes associated with polypharmacy. The literature shows that many trainees and practitioners are not confident in their abilities to care for this older population with complex medical conditions. We created an innovative simulation activity to teach safe, effective, and simplified medication management to second-year medical students. We developed the brown bag medication reconciliation simulation to improve self-efficacy and knowledge for trainees working with older adults. The case example was an older patient who presented with his brown bag of medications and prefilled pillbox for a medication reconciliation with his provider. Teams of medical students identified his medication-management errors and determined strategies for resolution. We assessed learner self-efficacy, knowledge, and satisfaction. A class of 137 second-year medical students completed the simulation. The average number of learners confident about medication management in older adults increased overall by 41%, with a significant increase across all four self-efficacy domains (p < .001). The average percentage of correctly answered knowledge questions significantly increased from 85% on the presurvey to 92% on the delayed postsurvey (p = .009). Learner open-ended feedback indicated high satisfaction with the simulation. The brown bag medication reconciliation simulation increased medical student self-efficacy and knowledge related to medication reconciliation and management for older adults. Interactive simulations like this one may be considered for inclusion in health science curricula to improve skills in medication reconciliation and management.

New Oral Anti-Cancer Drugs and Medication Safety.

Many oral anti-cancer drugs have come onto the market in the past 20 years. For example, kinase inhibitors, such as the BCR-ABL and BRAF inhibitors, have markedly improved the treatment of chronic myeloid leukemia and melanoma. In this review, we discuss the special challenges posed by poor adherence, drug-drug interactions with other substances, and side effects, among other problems, and the ways in which these challenges can be met. A selective search was carried out in PubMed for original and review articles on the safety of new oral anti-cancer drugs. Guidelines and current Summaries of Product Characteristics (SmPC) were also considered in the analysis. Review articles have pointed out numerous safety concerns with oral anti-cancer drugs. One of these is adherence, on which highly variable figures are available (with mean non-adherence rates ranging from 0 to 54%). The absorption of approximately half of these drugs is influenced by the patient's diet, and that of approximately 20% by gastric pH (Caution: proton-pump inhibitors may influence bioavailability). 70% of the active substances are metabolized primarily by CYP3A4, which means that their pharmacokinetics can be altered by grapefruit juice and CYP3A4 modulators. The prevention, detection, and treatment of side effects (which can be gastrointestinal, cutaneous, cardiovascular, or other) is a highly important matter. The increasing use of oral anti-cancer drugs confronts patients and treatment teams with special challenges. To optimize treatment outcomes, a multidisciplinary approach should be taken, involving physicians, pharmacists, and nurses. To improve medication safety, medication and side-effect management should be performed, and adherence should be regularly checked and systematically encouraged.

AN EXPLORATION OF HOME CARE NURSES’ EXPERIENCES IN DEPRESCRIBING OF MEDICATIONS FOR OLDER ADULTS IN THE COMMUNITY

The aim of this study is to explore the barriers and enablers of deprescribing from the perspectives of home care nurses, as well as to conduct a scalability assessment of an educational plan to address the learning needs of home care nurses about deprescribing. This study employed an exploratory qualitative descriptive research design, using scalability assessment from two focus groups with a total of eleven home care nurses in Ontario, Canada. Thematic analysis was used to derive themes about home care nurse’s perspectives about barriers and enablers of deprescribing, as well as learning needs in relation to deprescribing approaches. Home care nurse’s identified challenges for managing polypharmacy in older adults in home care settings, including a lack of open communication and inconsistent medication reconciliation practices. Additionally, inadequate partnership and ineffective collaboration between inter-professional healthcare providers were identified as major barriers to safe deprescribing. Further, home care nurses highlighted the importance of raising awareness about deprescribing in the community, and they emphasized the need for a consistent and standardized approach in educating healthcare providers, informal caregivers, and older adults about the best practices of safe deprescribing. Nurses in home care play a vital role in medication management and, therefore, educational programs must be developed to support their awareness and understanding of deprescribing. Study findings highlighted the need for the future improvement of existing programs about safer medication management through the development of a supportive and collaborative relationship among the home care team, frail older adults and their informal caregivers.

SAFER MEDICATION MANAGEMENT FOR HOME-DWELLING OLDER ADULTS

Taking several medications at the same time can lead to adverse effects and dangerous situations for home-dwelling older adults with chronic conditions. Accurate medication management can be a difficult challenge, especially for people living at home. However, little research has been carried out into the experience of older adults and their informal caregivers with medication management. The aim of the study is, first, to identify factors that can cause undesirable side effects and make taking multiple medications potentially dangerous for home-dwelling older adults. Second, the study will investigate the experiences of this group of patients with medication management. Third, the role of both professional and informal caregivers will be examined. Recommendations will be made on how to improve the safety of medication management for home-dwelling older adults with chronic conditions and should help to prevent the adverse effects and dangerous situations that can lead to hospitalization, institutionalization or premature death

The development and psychometric testing of Inpatients' Involvement in Medication Safety Scale (IIMSS).

To develop and test the psychometric characteristics of the Inpatients' Involvement in Medication Safety Scale. Medication safety is the third biggest challenge threatening patient safety. Patient involvement in medication safety management is essential, and however, few tools have been developed to assess the related process. The scale was formulated through literature review, semi-structured interviews and Delphi expert consultation. A group of 461 inpatients from a tertiary hospital were selected to examine the reliability and validity of the scale. The scale consisted of three dimensions and 23 items. Cronbach's α coefficient was 0.916 for the total scale and was 0.777-0.858 for three subscales; the test-retest reliability was 0.742 for the total scale. The content validity was 0.957, and the item content validity ranged from 0.833 to 1.000. The cumulative variance contribution of three selected factors was 51.19%. The Inpatients' Involvement in Medication Safety Scale has good reliability and validity and can be used to evaluate inpatients' involvement in medication safety. The scale provides theoretical reference for clinical nursing safety management, as well as helps nurses to provide targeted medication care for patients and their families.

Analysis of Issues and Future Trends Impacting Drug Safety in South Korea.

New drug safety issues are emerging that are beyond the existing medication safety management system. To pre-empt these problems, forecasting future drug safety trends and issues is a necessity. The objective of this study was to identify issues and future trends impacting drug safety using foresight methodologies. The study started by identifying global megatrends, trends in safety management of medicines, and key issues in drug safety. A total of 25 global megatrends were selected by extracting and clustering keywords from 26 reports concerning the future. Using the text-mining method, 10 trends in drug safety were identified from 3593 news articles. This study derived 60 issues which can arise from the trends, and finally, the 20 key issues with the highest urgency and impact scores were selected. Some examples of issues with high scores were as follows: illegal distribution of medicines, lack of technology for managing and utilizing big data, change in the pharmaceutical trade environment, lack of education and safety management for specific populations, lack of artificial intelligence-based technology for the safety management of medicines, and the prevalence of drug advertisements through social network services. The key issues could be used to establish plans for medication safety management.

Implementing eHealth Technologies: The Need for Changed Work Practices to Reduce Medication Errors.

Medication errors are a significant health problem and a serious threat to patient safety. In Norway, an estimated one-third of the elderly population has been exposed to potentially inappropriate medications. The Norwegian government has assumed a pivotal role in reducing medication errors and providing safer medication management for its citizens, particularly through the national eHealth system's e-prescription and Summary Care Record. In the present study, we depart from the governmental eHealth initiatives and examine why access to pharmaceutical information is not sufficient to solve the problem with medication errors. Empirical data were collected from 2015 to 2019 through the conduction of 56 qualitative interviews that were transcribed, thematically coded and analysed. The results illustrate how eHealth systems are helpful, at the same time, we emphasise changed work practices and professional knowledge-sharing as a basis for solving the issue of medication errors.

Discussion on establishing a surgical complications recording system using homepage of medical records

Objective To establish an adverse event monitoring system in the course of encoding medical record homepages, using the internationally accepted Clavien-Dindo surgical complications grading standard, for the purpose of hospital′s medical safety management. Methods The surgical complications record system was established based on encoded medical record homepages.Data of three types of medical therapies of the discharge cases of a tertiary hospital in 2017 were studied and the incidence, type and grading of the surgical complications were analyzed, to identify doctors′ missed diagnoses. Results A total of 588 surgical complications were detected from the discharge cases throughout the year.The incidence of surgical complications was 1.1%(588/52 319). The highest proportions of all surgical complications were infection and surgical incision problems.Grade Ⅱ complications accounted for the highest incidence rate(41.5%, 244/588); the proportion of missed surgical complications at the initial homepage was 62.2%(366/588), most of which being as grade Ⅱ complications(42.1%, 154/366). Conclusions The hospital adverse event monitoring system established based on the encoded medical record homepages features unified standard, making it feasible and universal, which serves an important role of the medical adverse event reporting system. Key words: Surgical complication recording system; Medical record homepage; Grading of complications; Type of complications